JACKSONVILLE, Fla. -- A mother who delivered a baby boy at Shands and soon after found her baby mislabeled as a girl said she was terrified about what might have happened.

"I always heard it about other people. Never thought it would happen to me," said Karen Butler.

Butler delivered her baby boy Kendrick Roberts at 1:44 a.m. at Shands Hospital last Saturday. It was what Butler said she discovered 12 hours later, the second time she saw her son that day, that she could not believe.

"My sister was holding him in the room and when she took off the blanket to see how long he was, I saw a name on his ankle. It was a girl name, and it said the mother's name, then the baby girl, then the last name of the mother."

When Butler saw her baby was mislabeled, it brought many worrisome thoughts.

"Anything could have happened. What if they gave him the wrong shot, or if they gave him the wrong medicine, anything. It was scary. I was terrified. They could have done the wrong blood work, had the wrong record sheet instead of testing him for what he was supposed to be tested for. It could be that baby girl, all her information, or anything."

All appears to be well with the child.

She said the the hospital staff apologized and said they would do better so it would not happen again. Butler, who has had 3 other children at Shands, said she won't go back there unless it's necessary. She has a word of warning to other mothers having a baby there.

"Be careful, watch them. Check your child's label, just be careful."

She heard from the hospital five days later and she said a woman there told her they were doing an internal investigation and would respond to her in 21 days by letter.

"Because of privacy concerns, we cannot comment on specific cases. However, we do have multiple systems in place to ensure the health and safety of every patient. Our hospital uses a series of checks and balances in all aspects of patient care in order to identify and resolve any potential problems."